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Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

Aggressive blood pressure and lipid-lowering treatment after stenting had the expected effect on those surrogate markers but didn't slow down atherosclerosis any better than standard intervention.

Note that the findings were a surprise but unlikely to have much impact on practice, suggested experts at the conference.

SAN DIEGO -- Aggressive blood pressure and lipid-lowering treatment after stenting had the expected effect on those surrogate markers but didn't slow down atherosclerosis any better in the Japanese MILLION trial.

Plaque volume fell to a similar degree whether the target was under 120/70 mmHg and 70 mg/dL LDL cholesterol or a more standard 140/90 mmHg and 100 mg/dL LDL cholesterol, Masa-aki Kawashiri, MD, of Japan's Kanazawa University, and colleagues found.

The plaque volume measured by intravascular ultrasonography (IVUS) after 18 to 24 months of treatment had declined by 8.74% in the aggressive group and by 9.37% in the standard treatment group -- both significant compared with baseline but not compared with each other.

The findings were reported at a late-breaking clinical trial session here at the Society for Cardiovascular Angiography and Interventions meeting.

The findings were a surprise but unlikely to have much impact on practice, experts here at the conference suggested.

One explanation for the lack of correlation in this trial might have been that the separation between groups was modest, conference program chair Michael R. Jaff, DO, medical director of the Massachusetts General Hospital Vascular Center in Boston, suggested.

"When we see something that surprises us and flies in the face of what is understood, it requires another look -- maybe a different cohort, larger numbers, longer follow-up," he told MedPage Today at a press conference.

Kawashiri suggested that the unexpectedly small differences in lipids and blood pressure between groups was more likely to be a factor than duration.

Blood pressure fell by 22.5/14.6 mmHg in the aggressive group and 15.0/5.1 mmHg in the standard group, significant differences in both systolic and diastolic comparisons for an overall separation of 7.5/9.5 mmHg.

Notably, the achieved blood pressures were well below guideline-recommended targets in both groups, at 114 and 124 mmHg systolic, respectively.

The LDL cholesterol separation was even smaller at 6.1 mg/dL, though significant at P=0.007 (53.5 versus 47.4 mg/dL reductions, respectively).

The 100 patients with IVUS measurements at the time of percutaneous coronary intervention (PCI) and a lipid level over 100 mg/dL at baseline with no prior lipid-lowering treatment were randomized to 5 mg of atorvastatin (Lipitor) and 2.5 mg of amlodipine (Norvasc) for the standard group or twice those doses for the aggressive group, atop other lipid-lowering and hypertensive medications as needed to get to the goals.

Session co-chair Gregg Stone, MD, of Columbia University Medical Center/New York-Presbyterian Hospital in New York City, pointed out that the statin dose used may look low but wasn't for the studied population.

"For those who might have been wondering, 20 mg of atorvastatin in Japanese patients is similar to 80 mg in the U.S.," he said. "They're very sensitive to the drug."

The 18 to 24 months of follow-up should have been sufficient to see an impact on IVUS if one was going to occur, SCAI president Charles Chambers, MD, of Penn State Hershey Heart and Vascular Institute in Hershey, Penn., told MedPage Today at a press conference.

Like the primary endpoint of coronary plaque volume, the lumen and vessel volume weren't different on IVUS between groups at that point.

The study didn't look at plaque composition, which is where the field is moving, Stone noted.

Study size shouldn't be overlooked as a potential explanation for the results, conference co-chair Roxana Mehran, MD, of Mount Sinai in New York City, added.

"As always when we see a study like this and are surprised, we need to look and first make sure of the sample size," she commented. "We get excited about something and it may or may not pan out when you study a larger sample."

"In general we tend to be aggressive," Charles Chambers noted. "Whether one study will govern our therapy is always a discussion."

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